EN
TÜRKÇE
Video Presentation - 4
Efficacy of Endoscopic Vacuum Therapy in Treating Large Esophageal Perforation in a Pediatric Patient
M Pickens, T Piester, N Pattamanuch, M Abts, A Utria, K Riehle, M Dellinger, A Krasaelap
Seattle Children's Hospital
Purpose: This study aims to demonstrate the potential of endoscopic vacuum therapy (E-vac) as an effective treatment for large esophageal perforations in a pediatric patient.
Methods: We present the case of a 7-year-old girl with a history of repaired esophageal atresia and tracheoesophageal fistula (type C), complicated by recurrent respiratory illnesses due to severe mid-to-distal tracheomalacia. She underwent rotational esophagoplasty and posterior tracheobronchopexy, during which an esophageal injury occurred. A primary repair of the esophageal perforation was performed, with a negative intraoperative leak test. Chest tubes were placed, along with broad-spectrum antibiotics; nothing by mouth and parenteral nutrition was started. An extraluminal leak was observed on the esophagram by postoperative day (POD) 5. On POD 10, the Gastroenterology team initiated E-vac therapy to facilitate healing.
Endoscopy revealed a 2x3 cm perforation at the proximal esophagus. An E-vac system, comprising a cylinder sponge sutured to a suction tube, was introduced nasally or via the gastrostomy site and positioned at the perforation site. The system was connected to continuous suction and exchanged every 3-7 days while the patient received parenteral nutrition, broad-spectrum antibiotics, chest tube drainage, and respiratory support. Additional procedures included endoscopic brushing, argon plasma coagulation (APC), and the application of PuraStat® to address persistent esophagopleural fistulae.
Results: Following 2.5 months of E-vac therapy and adjunctive interventions, the patient achieved oral intake with supplemental gastrostomy tube feeds and had significant clinical improvement. A follow-up endoscopy showed complete healing of the esophageal perforation.
Conclusion: E-vac therapy is an effective treatment option for esophageal perforations, in addition to brushing, APC, and PuraStat® application for esophagopleural fistulae.